Many reluctant to tell docs about depression: study

NEW YORK (Reuters Health) - Some people with depression symptoms may not tell their family doctor about it -- often out of worry they will be placed on an antidepressant, a new study suggests.

In a survey of more than 1,000 California adults, researchers found that 43 percent had at least some misgivings about telling their primary care doctor about any depression symptoms.

Their top concern was the possibility that their doctor would prescribe an antidepressant -- a worry voiced by 23 percent of the whole study group.

Another 16 percent thought it was not their doctor's job to "deal with emotional issues." And a similar percentage worried that someone -- like an employer -- might see a diagnosis of depression on their medical records.

Researchers led by Robert A. Bell, of the University of California, Davis, report the findings in the Annals of Family Medicine.

"This study raises interesting issues that have not really been addressed before," said Dr. David Hellerstein, of the New York State Psychiatric Institute and Columbia University Medical Center in New York.

According to Hellerstein, who was not involved in the study, past research has generally focused on the doctor's side of things -- like whether and how they ask patients about depression symptoms.

Now it would be helpful for studies to look into the reasons that people harbor the attitudes that they do, Hellerstein told Reuters Health.

Regarding the finding on antidepressants, he said, "on one level, it doesn't make sense. If you have depression, why would you worry about getting a treatment that's effective?"

But some people may worry about side effects, or that medication won't help them, Hellerstein noted.

The most common side effects of antidepressants include constipation, headaches, dizziness, sleep problems and weight gain. The drugs have also been linked to reports of suicidal behavior in children and young adults.

As for effectiveness, about 60 percent of people who go on antidepressants "feel better" with the first medication they try, according to the U.S. Agency for Healthcare Research and Quality.

In the current study, though, people seemed to have more misgivings about antidepressant treatment than they did about "talk therapy." Just under 14 percent said they might not tell their doctor about any depression symptoms out of concern they would be referred for counseling -- versus the 23 percent who cited antidepressant worries.

Hellerstein said that 20 years ago, there might have been more stigma attached to "talking about your feelings." But that may be lessening now.

The findings are based on telephone interviews with 1,054 California adults who were asked about their beliefs about depression, and "perceived barriers" to getting care for it. They were also screened for current depression symptoms, and asked about any past depression treatment.

Overall, 153 respondents screened positive for moderate to severe depression. And they were more likely than others to have an aversion to antidepressant treatment -- 28 percent versus 18 percent. They also tended to see more obstacles overall.

"Ironically," Bell's team writes, "those who most subscribed to potential reasons for not talking to a primary care physician about their depression tended to be those who had the greatest potential to benefit from such conversations."

Hellerstein said it was "kind of alarming" that about 16 percent of study participants thought that mental health was not part of their doctors' job.

"Yes, this is something you can talk to your primary care doctor about," he said.

And people who don't want to take antidepressants should know they don't have to. "There are different treatment approaches," Hellerstein said. "But medication and psychotherapy can be effective."

As for alternative remedies, there is some evidence from clinical trials that St. John's wort -- already used in Europe as a depression treatment -- can help with mild to moderate symptoms.

The most common form of psychotherapy for depression is cognitive behavioral therapy, which usually involves between 10 and 20 sessions.

Some drawbacks are the fact that not everyone will have a therapist in their local area, as well as the cost: prices vary, but commonly range between $100 and $150 per session. Many insurance plans do at least partially cover the cost.

Antidepressants can be costly as well. The monthly price tag can range from around $20 to several hundred, depending on the medication and the dose. It typically takes about six weeks for people to feel a benefit, and then they are usually told to keep taking their medication for 6 to 12 months, or sometimes longer.